Revalidation and assessment: giving marks might help.
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Biomedical subjects
Publications and source records attributed to R Lehman.
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BACKGROUND: Ketorolac is a very useful medication in gynecologic surgery, providing pain relief and less narcotic use. This greatly shortens the recovery time and length of hospital stay. As with other nonsteroidal antiinflammatories, gynecologists are aware of the potential for bleeding problems from ketorolac, yet those bleeding complications have rarely been seen in gynecology and have not been previously reported in the gynecologic literature. A recent case demonstrates the serious complication that can occur when ketorolac inhibits platelet function postoperatively. CASE: A 36-year-old woman began bleeding intraabdominally shortly after an otherwise-unremarkable vaginal hysterectomy done under spinal anesthesia. CONCLUSION: A literature review suggests that this complication is highly associated with nongeneral anesthesia surgery, such as spinal, epidural and conscious sedation. This fact, however, has not been published in the gynecologic literature and is not well known to gynecologists. Pending further elucidation of this problem, avoidance of ketorolac perioperatively with nongeneral anesthesia cases should be considered.
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The cases of 23 patients with unilateral combined central retinal artery-central retinal vein obstruction are described. Criteria for the abnormality included: a history of relatively sudden visual loss; superficial retinal whitening in the posterior pole in combination with a cherry spot; and intraretinal blood, generally associated with dilated and/or tortuous retinal veins. In five instances (22%) the obstructions developed after retrobulbar injection. Among the 21 patients with followup for at least 6 months, or until the onset of neovascularization of the iris, 17 (81%) developed rubeosis iridis. Late histopathology was obtained in two eyes. Hemorrhagic necrosis of the retina was observed in some areas of the posterior pole and attenuation of the inner retinal layers, similar to that seen with late central retinal artery obstruction, was noted elsewhere. Periphlebitis of the central retinal vein within the optic nerve was found in each case.
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A technique is described in which "jingle bells" are sutured in three positions on the face at the points of maximum excursion of the facial musculature when stimulated by a Hilger nerve stimulator set at 2 mA. The procedure is used to monitor movement of the facial nerve while the surgeon dissects the nerve in the cerebellopontine angle and internal auditory canal.
Numerous studies have demonstrated a significant depression in performance IQ (PIQ) in Turner Syndrome (TS) females, but the neuropsychological interpretation of this finding remains unclear. The present study addressed the following questions regarding the neuropsychological phenotype in TS: Are TS women neuropsychologically impaired? Is the impairment lateralized and How consistent is the neuropsychological phenotype across TS individuals? Unlike previous studies, the present study utilized both normal and brain damaged female controls. All subjects were given an extended Halstead-Reitan neuropsychological battery. The TS females were significantly worse than normals but not significantly different from brain damaged females in their overall level of neuropsychological functioning. However, their impairment was not lateralized. Their pattern of lateralizing findings was similar to that found in the Diffuse and Normal groups, but significantly different from either the right or left unilateral lesion groups. Fairly consistent deficits were found on tests of visuospatial skills and long term memory, but there was considerable variability in all the other test findings among TS individuals. The results are discussed in relation to the recent findings (Inglis and Lawson, 1981) that verbal-performance IQ discrepancies may be unreliable indicators of lateralized cerebral dysfunction in females. Hence the depressed PIQ in TS appears not to indicate predominantly right hemisphere dysfunction and may not even indicate a consistent underlying neuropsychological phenotype.
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